极低出生体重儿添加母乳强化剂时机的回顾性研究

A Retrospective Study on the Timing of Human Milk Fortifier Supplementation in Very Low Birth Weight Infants

摘要: 目的：探讨极低出生体重儿母乳强化剂(Human Milk Fortifier, HMF)添加时间对早期喂养、生长发育及神经系统发育的影响，旨在为极低出生体重儿院内精准化喂养提供科学依据。方法：采用回顾性分析方法，对2023年9月至2025年9月期间安徽医科大学第一附属医院新生儿科收治的118例母乳强化喂养的极低出生体重儿病例进行研究。根据HMF添加时间，将病例分为早强化组和晚强化组。早强化组在母乳喂养量达到50~80 ml/(kg·d)时添加HMF，晚强化组则在母乳喂养量超过100 ml/(kg·d)时添加HMF，收集两组的临床资料进行统计分析。结果：两组患儿出院时体重、头围、身长、血清尿素氮、前白蛋白、钙、磷、25-羟维生素D指标均无显著差异(p > 0.05)；纠正40周龄时的生长发育和新生儿行为测定亦无显著差异(p > 0.05)。然而，晚强化组的喂养不耐受发生率、医院内感染发生率和住院天数均显著低于早强化组(p < 0.05)。结论：对于极低出生体重儿，住院期间采用适当的晚强化喂养方案更有助于早期临床管理。

Abstract: Objective: To investigate the effects of the timing of Human Milk Fortifier (HMF) initiation on early feeding tolerance, postnatal growth, and neurodevelopmental outcomes in Very Low Birth Weight Infants (VLBWI), and to provide a scientific basis for optimizing precision in-hospital feeding strategies for this population. Methods: A retrospective analysis was conducted on 118 VLBWI who received HMF-fortified breast milk and were admitted to the Department of Neonatology, the First Affiliated Hospital of Anhui Medical University, between September 2023 and September 2025. Infants were assigned to either an early fortification group or a late fortification group based on the timing of HMF introduction. In the early fortification group, HMF was initiated when the enteral feeding volume reached 50~80 mL/(kg·d), whereas in the late fortification group, HMF was initiated after the feeding volume exceeded 100 mL/(kg·d). Clinical data were collected and statistically compared between the two groups. Results: No significant differences were observed between the two groups in terms of weight, head circumference, length, or serum levels of urea nitrogen, prealbumin, calcium, phosphorus, or 25-hydroxyvitamin D at discharge (all p > 0.05). Similarly, at 40 weeks postmenstrual age, there were no significant intergroup differences in anthropometric measurements or Neonatal Behavioral Neurological Assessment (NBNA) scores (all p > 0.05). However, the late fortification group exhibited significantly lower incidences of feeding intolerance and nosocomial infection, as well as a shorter duration of hospitalization, compared to the early fortification group (all p < 0.05). Conclusion: For VLBWI, an appropriately delayed strategy for HMF fortification during hospitalization appears to be more conducive to early clinical management.